Adherence to an ideal cardiovascular health (CVH) might contribute to lower the burden of sudden cardiac death (SCD) in the community. We aimed to examine the association between the number of ideal CVH metrics at baseline and of its change over 10 years with the risk of SCD. The Copenhagen City Heart Study is a community-based prospective cohort study. The number of ideal CVH metrics (range 0-6; non-smoking and ideal level of body mass index, physical activity, untreated glucose, untreated systolic blood pressure, and untreated total cholesterol levels) at baseline in 1991-94 and its 10-year change thereof between 1981-83 and 1991-94 were evaluated. Definite SCD was defined as a death occurring within 1 h (eye-witnessed case) or within 24 h (non-eye-witnessed) of symptoms onset, with the presence of confirmed ventricular tachycardia and the exclusion of non-cardiac cause at autopsy. Fine and Gray sub-distribution HRs (sHRs) were calculated to account for competing risk. The study population includes 8837 participants (57% women; mean age 57 years, ±15 years) in 1991-94. After a median follow-up of 22.6 years from 1 January 1993 up to 31 December 2016, 56 definite SCD occurred. The risk of definite SCD decreased gradually with the number of ideal metrics in 1991-94 [sHR = 0.58; 95% confidence interval (CI): 0.44-0.75 per additional ideal metric] and with the change (i.e. improvement) in the number of ideal metrics between 1981-83 and 1991-94 (sHR = 0.68; 0.50-0.93 per change in the number of ideal metrics). Effect size was lower for coronary death, all-cause mortality, and coronary heart disease events. Adherence to a higher number of ideal cardiovascular health was related to a substantial lower risk of definite SCD.